Hybrid Program Integrity Auditor — Medicaid Compliance

Alliance Health; Morrisville (NC); Hybrid; USD 46,000 - 59,000; Full time

Benefits offered by this job

Medical benefits

Retirement plan

Hybrid/Remote options

PTO and holidays

Dress code flexibility

Job summary

Alliance Health is seeking a Program Integrity Auditor to perform post-payment and prepayment audits of Medicaid and state-funded providers. You will analyze data, identify improper payments, and document findings for leadership review. The role requires collaboration across regulatory, clinical, and operational teams.

The position is full-time and hybrid, with travel to Alliance catchment areas as needed. A Bachelor's degree in health care compliance or related field plus 3 years of experience

Qualifications

• Bachelor’s degree in health care compliance, analytics, government/public administration, auditing, security management, criminal justice, or pre-law with 3 years of post-degree healthcare compliance experience.

Responsibilities

• Conduct post-payment and prepayment audits of Medicaid and state-funded providers to ensure compliance.
• Develop audit plans and tools based on services audited.
• Request and collect medical records and related documents for audits.
• Document evidence and audit findings in detailed reports and present results to leadership.
• Perform provider enrollment due diligence and assess licensure and qualifications.
• Research clinical policies and applicable laws to identify noncompliance.
• Analyze data from claims, authorizations, enrollment, grievances, and audits to inform decisions.
• Educate providers on audit findings and recommend corrective actions.
• Travel as needed to meet with members, providers, and stakeholders.

Skills

Medicaid knowledge

Auditing

Data analytics

Regulatory analysis

Claims adjudication

Education

Bachelor's degree in health care compliance/analytics

Bachelor's degree in auditing/administration

Job description

Alliance Health is seeking a Program Integrity Auditor to perform post-payment and prepayment audits of Medicaid and state-funded providers. You will analyze data, identify improper payments, and document findings for leadership review. The role requires collaboration across regulatory, clinical, and operational teams.

The position is full-time and hybrid, with travel to Alliance catchment areas as needed. A Bachelor's degree in health care compliance or related field plus 3 years of experience